Case Manager - Utilization Management

Lehigh Valley Health Network

Remote, Pennsylvania, United States
Fully remote
Licensed registered nurse in pennsylvania
2 years utilization review experience
Knowledge of third party payer requirements
Lehigh Valley Health Network is hiring a fully remote Case Manager for Utilization Management to ensure the appropriate use of hospital resources and compliance with third-party payer requirements. The ideal candidate will have a nursing background with experience in utilization review and demonstrate strong teamwork and communication skills

Job Summary

  • The role ensures appropriate use of hospital resources by reviewing all admitted patients and evaluating the appropriateness of admission using approved criteria.
  • Candidates will partner with unit-based care managers and collaborate with billing, coding, and finance teams to facilitate accurate patient class assignments and maximize reimbursement.
  • Lehigh Valley Health Network is a Magnet Hospital recognized for nursing excellence and has been ranked among the Best Hospitals by U.S. News & World Report for 23 consecutive years.

Matching Summary

Match Score: 85

Lehigh Valley Health Network is hiring a fully remote Case Manager for Utilization Management to ensure the appropriate use of hospital resources and compliance with third-party payer requirements. The ideal candidate will have a nursing background with experience in utilization review and demonstrate strong teamwork and communication skills.

Skills & Requirements

Must-have

  • Licensed Registered Nurse in Pennsylvania
  • 2 years utilization review experience
  • Knowledge of third party payer requirements
  • Evidence-based clinical decision support criteria
  • Strict adherence to HIPAA confidentiality

Nice-to-have

  • Bachelor's degree in nursing
  • InterQual or MCG criteria knowledge
  • ACM, ACMA, CCM, or CMCN certification
  • Teamwork and flexibility in prioritized needs
  • Positive attitude and attention to detail

Key Requirements

  • RN License in Pennsylvania required upon hire
  • Minimum 2 years utilization review experience
  • Specialized Diploma in nursing
  • Knowledge of utilization management for third party payers

Work Rights

Not specified

Tailored Resume

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